DEPARTMENT OF GENERAL MEDICINE
8th SEMESTER Ist - INTERNAL ASSESSMENT EXAMINATION JULY – 2023
Date: 14.07.2023
Time: 10 am to 1 pm Max Marks: 100
Note: Answer all questions. There are 5 questions surrounding a clinical vignette borrowed from the e log books (case based online learning portfolios) of each student shared in the links below, each with a long essay question of 10 marks, short essay question of 5 and MCQ of 5 marks. Thousands of online learning portfolios of our students along with the deidentified case report data can be accessed from our dashboard here: http://medicinedepartment.
1) A 33 YR man, FLOWER POT MAKER BY OCCUPATION, RESIDENT OF BONAGIRI, CAME TO OPD WITH CHIEF COMPLAINT of Abnormal movements in his upper limbs since 5 years and difficulty in walking since 5 years. The patient is apparently asymptomatic 5 years back then he started developing abnormal involuntary movements in his upper limbs since 5 years. The movements were noticed during rest and also while walking. He haS difficulty in walking initiation and once he walks, he walks with short sride length and freezes during turning.There is also decreased swinging of hands while walking. Also noticed difficultly in speaking.
1) LAQ 10 marks
Approach to anatomic and etiologic differential diagnosis and therapeutic considerations in persons with a movement disorder
2) SAQ 5 marks
Etiology, diagnosis and therapy of Parkinson's disease
3) MCQ 5 marks :
Triad of Parkinson's disease consists of all except :
a) Tremor
b) Rigidity
c) Spasticity
d) Bradykinesia
2) 22 year male auto driver by occupation came to opd on 16th june with chief complaints of fever since 15 days, vomiting since 12 days and yellowish discoloration of eyes since 12 days. On examination, he is febrile, his sclera and tongue undersurface appears yellow and lab results reveal thrombocytopenia along with raised bilirubin, AST, ALT and alkaline phosphatase and normal albumin in his LFT.
1) LAQ 10 marks
Approach to anatomic and etiologic differential diagnosis and therapeutic considerations in persons with fever as described above
2) SAQ 5 marks
Diagnosis and therapy of dengue with hepatitis
3) MCQ 5 marks :
Dengue viral disease is associated with all except :
a) Thrombocytopenia
b) Absent NS1
c) Saddle back fever
d) islands of green in a sea of blue
3) 43 year old man who works at a petrol pump and is resident of Narketpally presented with shortness of breath since 15 days, abdominal distention since 15 days and 5-6 episodes of vomiting 6 days ago and diabetes and hypertension since 3 years. On examination, he has Jaundice, mild tachypneoa, doubtfully raised JVP, distended abdomen with shifting dullness
1) LAQ 10 marks
Approach to anatomic and etiologic differential diagnosis and therapeutic considerations in persons with abdominal distension and shortness of breath as described above.
2) SAQ 5 marks
Etiologic diagnosis and specific therapy for patients presenting with portal hypertension
3) MCQ 5 marks :
Fatty liver disease is associated with all except :
a) Visceral fat
b) parotidomegaly
c) coronary artery disease
d) Xanthoma
4) 52 year old man, resident of lingotam,farmer by occupation came to the casualty with chief complaints of involuntary movements of the right lower limb since morning(6:00am) with numbness of right lower limb. He has diabetes since 15 years.( on medication since 8 years and on insulin from 2 years)and hypertension since 5 years.Right fore foot amputation secondary to diabetic gangrene 2 years back. Left lower leg amputation secondary to diabetic gangrene 3 months back. On examination he has in addition reduced power of 4/5 in both lower limbs and fasciculations over calf muscles along with areflexia.
1) LAQ 10 marks
Approach to anatomic and etiologic differential diagnosis and therapeutic considerations in persons having paraparesis with Diabetes as described above
2) SAQ 5 marks
Etiologic diagnosis and specific therapy for patients presenting with various complications related to Diabetes
3) MCQ 5 marks :
Characteristics of paraparesis due to peripheral nerve disease in diabetes is associated with all except :
a) Fasciculations
b) Areflexia
c) hypertonia
d) loss of sensation
5) 42 year old man , resident of Choutupal, daily wage labourer by occupation was apparantly asymptomatic 1 1/2 yr back, then he said after taking covid vaccination he developed fever.So he visited our hospital and he was diagnosed with hypertension and renal cyst. After 6 months he developed shortness of breath and pedal edema upto ankle for a week. Then they visited Gandhi hospital where dialysis was done for him and was admitted in hospital for nearly 20 days.
15 days back after dialysis was done, he developed watering eye in the right eye,peri orbital swelling was developed,tenderness was present,no eryyhema and then gradually vision was lost in that eye with in 5 days. After 7 days he noticed nasal bleeding from right nostril. He also develped an ulcer like wound on his right nadolabial fold of nose.On examination of eye, the right eye showed:
mild swelling of upper lid
Conjunctiva is muddy
Cornea is clear
Loss of vision with no counting fingers ,perception of light
Ocular movements are limited in all
Directions
Direct and indirect Light reflex are absent
On palpation mild tenderness is seen.
Nose
Epistaxis from right nostril
Mild tenderness is present in maxillary region.
Ulcer like wound is present om the right nasolabial fold of nose.
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) LAQ 10 marks
Approach to anatomic and etiologic differential diagnosis and therapeutic considerations in persons with sudden loss of vision and medical, otorhinological comorbidities as described above
2) SAQ 5 marks
Etiologic diagnosis and specific therapy for patients presenting with various complications related to chronic renal failure
3) MCQ 5 marks :
Characteristics of vision loss due to orbital cellulitis with medical comorbidities is associated with all except :
a) Blindness
b) Sinusitis as a possible etiology
c) Hypertension
d) loss of extraocular movements
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